Pain Case Report: Cramping, Foreign Body in Stool

A child presents to the emergency department with a seven-inch live worm in his stool.

The pediatric patient reported abdominal cramping.

A 7-year-old male presents to the emergency department (ED) after school, reporting abdominal cramps and a foreign body in his stool. He is a Spanish-speaking child accompanied by his mother.

History

The child was healthy, with no prior medical problems. His mother says that he called her into the bathroom after school regarding something in his stool. He had some abdominal cramping on the bus on the way home. He had eaten his breakfast and lunch, which consisted of nothing unusual. There was no past history of similar complaints prior to this visit.

The child had no surgical history or prescription medication use. All vaccinations were up to date. He and his family relocated from Mexico two years ago, and they have not returned there since. He had received routine medical care since coming to the United States. No pets were in the home, and there had been no recent travel.

The child denied any ingestion of soil or other inedible objects. The mother said that he did not have a fever, weight loss, or fatigue. She denied any cough, bloody sputum, trouble breathing, or reports of chest discomfort. She had no knowledge of any nausea, vomiting, other previous abdominal pain, or change in his bowel habits, which were usually daily and consisted of formed brown stool.

Physical exam

On physical exam, a thin and well-appearing child was noted. He was well-groomed and cooperative with the examination. His vital signs were all within normal limits. His skin tones were pink, and his mucous membranes were moist. His skin temperature was warm, with no rashes or lesions noted. His respirations were easy, and his lungs were clear and equal throughout all fields.

His apical rate was regular and strong, with no murmurs, gallops, or rubs. His abdomen was soft and slightly scaphoid in appearance. He had normoactive bowel sounds in all quadrants. The percussion note was tympany. There was no pain with light or deep palpation, nor was there guarding, rebound, or flank pain.

There were no masses or hepatosplenomegaly. Inspection of the anus revealed good rectal tone, without any fissures, hemorrhoids, or foreign bodies. Inspection of the specimen that the mother had brought to the ED revealed a single, approximately 7-inch live worm, cylindrical in shape and pink-brown in color. There was a trace amount of brown substance on the worm, and a foul smell was noted.